Ambetter Prior Auth

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DISCLAIMER:

All attempts are made to provide the most current information on the Pre-Auth Needed Tool. However, this does NOT guarantee payment. Payment of claims is dependent on eligibility, covered benefits, provider contracts, correct coding and billing practices. For specific details, please refer to the provider manual. If you are uncertain that prior authorization is needed, please submit a request for an accurate response

Vision services including any services rendered by an Optician, Optometrist or Ophthalmologist need to be verified by Envolve Vision
Dental services need to be verified by Envolve Dental
Complex imaging, MRA, MRI, PET, and CT Scans need to be verified by NIA
Musculoskeletal Services need to be verified by Turning Point
Oncology/supportive drugs need to be verified by New Century Health

Services provided by Out-of-Network providers are not covered by the plan. Join Our Network

Are Services being performed in the Emergency Department?

Services being performed in the Emergency Department do NOT require prior authorization

Yes
No

Types of Services

YES

NO

Are the services being performed or ordered by a non-participating provider?

serviceQuestion-0

serviceQuestion-0

Is the member being admitted to an inpatient facility?

serviceQuestion-1

serviceQuestion-1

Are anesthesia services being rendered for pain management or dental surgeries?